SHC Cardiology Telemedicine

Since the COVID-19 pandemic hit the U.S., healthcare providers have turned to telemedicine visits (by video and telephone) as a valuable alternative to standard in-person visits. Over a year later, many medical practices are unsure of the degree to which they should continue utilizing telemedicine as well as the significance of the patient benefit. Our project studied this question for Stanford Healthcare’s Cardiovascular Medicine by interviewing stakeholders involved in the patient scheduling process and analyzing the variation in telemedicine use by provider, patient, and visit characteristics in order to highlight insights about telemedicine usage and processes over the last year. 

Understanding the process by which a patient visit was scheduled was our first contribution as different specialties and different departments have slightly different practices. Through insights gathered from our stakeholder interviews, we narrowed our focus to General Cardiology and their practices. We found that the determination of visit modality for a new patient begins with a Nurse Practitioner (NP) assessing whether or not a telemedicine visit is clinically appropriate for the given referral, given the understood visit purpose. Next, a New Patient Coordinator (NPC) evaluates provider availability and preferences, and provides patients with scheduling options for their visit. For return visits, the patient’s provider determines which visit modalities are acceptable, then a Patient Care Coordinator (PCC) works with the patient to schedule the next visit. PCCs also help patients prepare their tech for telemedicine visits.

We discovered a number of key issues in this process. First, the referrals received by NPs do not always contain the standardized information necessary to make an appropriate determination of a telemedicine or in-person visit. Secondly, high referral volumes, low provider availability, and increased workload for PCCs (due to taking on tech support roles for patients with telemedicine visits) make scheduling challenging for the care coordinators. Thirdly, providers were curious to know if there were ways to optimize telemedicine visits for certain kinds of patients and wanted to know the usage patterns of current telemedicine visit scheduling. 

Through our stakeholder interviews, we were able to address the first issue: information pain points that the NP’s face. We were able to address the third issue by understanding how different patient and non-patient factors impacted telemedicine visit scheduling through data analysis of patient encounters. In doing so, we systematically eliminated potential sources of variability in visit modality assignment for patients until we narrowed in on physician preference as the cause for a majority of the variability. 

Our key insights from our analysis include:

1. NPs make the best visit modality allowance decision they can given the information available to them when they view a referral. It would be hugely beneficial to standardize and require certain pieces of information on all incoming referral sheets.
2. NPs, when given all information necessary, are highly efficient at making an appropriate clinical assessment regarding visit type, and this decision can be reproduced by means of a few key questions. 
3. Provider preferences are one of the most significant sources of variation in telemedicine use, according to both our data analysis and interview insights. Limiting variability across provider preference will help standardize visit scheduling, simplifying NPs’ decision-making for certain referrals. Longer-term patient outcomes due to telemedicine use can be better measured after these changes are implemented.